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Cheshire East Safeguarding Adults Board – Annual Report 14/15

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Contents

Forward Page 4 Local Context Page 5

Background Page 6

Vision & Principles Page 6/7 Service User Engagement Page 7

Business 14/15 Page 8/9 Statements from partners Page 9

Annual Assurance Page 20 Domestic Abuse Page 21

How have we made a difference Page 22

What next? 2015/16 Page 23 Appendix 1 - Easy Read Statements Page 24

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Foreword I have been delighted to fulfil the role of Interim Independent Chair during 2014/15. This has been a busy year for the board in preparing for the implementation of the Care Act 2014. For the first time, adult safeguarding boards will be a legal requirement from 1st April 2015, with a range of statutory duties that are aimed at ensuring that key partners work together effectively to improve safeguarding, wellbeing and independence. During 2014/15, CESAB has carried out a full review of its constitution to ensure that it is able to fulfil its new statutory duties. This has included reviewing the membership and the purpose of the board as well as working closely with our service user reference group to ensure that the work of the board “makes safeguarding personal”. The Care Act requires the board to produce a Strategic Plan that sets out our goals and priorities in consultation with the public. During the latter part of 2014/15 we have therefore carried out a public consultation exercise and have developed our priorities for going forward into 2015/16 based on the issues people raised with us. Protecting & safeguarding people at risk of abuse or neglect is an important job, and we have taken steps to start working more closely with other partners. As well as building on our close relationship with the Children’s Safeguarding board and Cheshire East Domestic Abuse Partner-ship (CEDAP) we have met with the Community Safety Partnership and Health & Wellbeing Board to ensure that we work together more effectively on those cross cutting issues that affect us all. During my time as Interim Chair, I have been impressed with the commitment and hard work of all of the partner agencies, and in particular the commitment to listen to people who have had experience of safeguarding processes and to learn from those experiences. I have no doubt that the board will continue to build on its current strengths to meet the challenges ahead.

Kathy McAteer

CESAB Independent Chair 2014/15

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Local context

Cheshire East has a population of 372,100 people, 11,700 of which are aged 65 or over.

There is an estimated 3,300 residents over the age of 90. The number of residents over the

age of 65 is expected to increase substantially by 26% by 2021. The risk of people being

susceptible to abuse is high. This is illustrated by the charts below highlighting adult

safeguarding activity in the borough during 14/15:

0 100 200 300 400 500 600

Own Home

Care Home - Permanent

Nursing Home Permanent

Supported Accommodation

Care Home Temporary

Acute Hospital

Not Known

Mh Inpatient Setting

Other

Public Place

Alledged Perpetrators Home

Day Centre / Services

Nursing Home Temporary

Community Hospital

Other Health Setting

Education/ Training /Workplace

Total of all Referrals by Location of Abuse

0

20

40

60

80

Nature of Abuse

Discriminatory Financial Institutional Neglect

Physical Psychological Sexual

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Cheshire East Safeguarding Adults Board The Cheshire East Safeguarding Adults Board (CESAB) is the strategic body that oversees multi-agency working to assure that adults at risk from abuse and neglect are safeguarded effectively. The Board is committed to ensuring that all agencies working in Cheshire East and the wider community work together to minimise and reduce the risk of abuse and neglect to adults at risk. This report summarises CESAB’s activities that has taken place between April 2014 and March 2015. It highlights the commitment to multi-agency working; the robust performance management and quality assurance mechanisms in place and the achievements of the CESAB. Safeguarding adults maintained a high profile during 2014-15 locally, regionally and nationally both in terms of Government initiatives and in the media. Multi-agency working to prevent abuse and safeguard adults at risk has continued to be scrutinised. 2014-15 saw a number of new guidance notes and reports being produced to aid organisations to work more effectively together to prevent abuse and neglect. The Care Bill received Royal Assent in May 2014, becoming the Care Act 2014. In preparation for the Care Act 2014 and Making Safeguarding Personal (national guidance that promotes putting service users in control of the safeguarding process), CESAB established clarity with its partners during 14/15 about the board’s purpose, remit and function. Membership, roles and responsibilities – including common understanding of terms, were also reviewed and a reformed CESAB Constitution document was produced.

Vision and Principles The strategic objectives and work of the Board is based on the following vision: People in Cheshire East have the right to live a life free from harm, where communities: • have a culture that does not tolerate abuse • work together to prevent abuse • know what to do when abuse happens

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Principles The work of the Board is underpinned by the following principles:

- Empowerment – Personalisation and the presumption of person-led decisions and informed consent. “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”

- Prevention – It is better to take action before harm occurs. “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”

- Proportionality – Proportionate and least intrusive response appropriate to the risk presented. “I am sure that the professionals will work for my best interests, as I see them and they will only get involved as much as needed.”

- Protection – Support and representation for those in greatest need. “I get help and support to report abuse. I get help to take part in the safeguarding process to the extent to which I want and to which I am able.”

- Partnership – Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. “I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together to get the best result for me.”

- Accountability – Accountability and transparency in delivering safeguarding. “I understand the role of everyone involved in my life.”

Service User Engagement CESAB believe that effective safeguarding of people in Cheshire East requires participation and engagement from across agencies, volunteers, communities and users and their families. At the heart of all CESAB’s work during 204/15 was the views and experiences of the people who are directly affected by the work overseen by the Board through:

Following the standards for participation developed by the user group ensuring that the voice of users and the impact of activity was considered in all aspects of its business

Service Users were involved directly in evaluating multi-agency practice through the Performance and Quality group and the national Safeguarding Outcomes Measure Pilot Study

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Business 2014/15 CESAB met on 6 occasions in 2014/2015 – five Business Meetings and an Annual Review session. During this period CESAB was chaired by an independent person and operated with the following nine standing sub-groups. However, a new board structure will be introduced from April 2015. SERVICE USER REFERENCE As stated, it is a priority of the Board to include service users, carers and the public in the work it’s doing to keep people safe. This group determines the way that Adult Social Services and partners work with its service users, carers & the public. Information and advice from our service users helps to improve the Safeguarding Adults process and policy development. MCA/ DOLS GROUP This group was formed in Spring 2014 and ran for a 12 month period before the new structure was introduced. Its purpose was to oversee the governance arrangements of Mental Capacity Act and Deprivation of Liberty Safeguard legislation across Cheshire East; quality assuring Local Authority implementation of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards, on behalf of Cheshire East Safeguarding Adults Board. PREVENTION & PUBLIC AWARENESS Ensures that awareness of adult safeguarding is promoted across the borough and that mindful consideration is given to all communities within the borough including minority groups. One of the responsibilities of the group is to develop and review information for public and professionals regarding safeguarding adult issues. PROTECTION This sub group carries out the development of policies, procedures and protocols for adult safeguarding. Its function is to ensure that all policies and procedures are both appropriate and operable. The group promotes effective working relationships between partner organisations and professional groups and facilitates a shared understanding and agreement about operational practices through policy development. INFORMATION INTELLIGENCE QUALITY AND AUDIT As the board is responsible for ensuring that national policy and guidance is being adhered to locally, this subgroup develops a local mechanism of audit and quality assurance to ensure that a consistent approach is maintained across all partner organisations. TRAINING & LEARNING DEVELOPMENT ensures that development needs of staff and

partners working with vulnerable adults have been agreed and that there is a broad range of training initiatives in place. The group ensures that both single and multi-agency training is delivered to a consistently high standard in all areas and that a process exists for evaluating its effectiveness. E-SAFFETY as society increasingly uses social networking and other developing media to communicate, it is critical that safeguarding protocols and practices keep pace with the raft

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of communication methods in use. This group advises both the LSCB and LSAB on of potential safeguarding risks linked with technology and how this can be addressed. CASE REVIEW GROUP The overall purpose of this sub-group is to ensure when a Safeguarding Adults Review (SAR) is required that the panel and process is robust and clear. SAFER WORKING this joint Children’s and Adults Safeguarding Boards sub-group ensures that all agencies working or in contact with Vulnerable adults and children operate recruitment, supervision, management and working practices to safeguard vulnerable adults and children It is important to note however, that the constitution review work undertaken during 2014/15 will see the board working to a reformed structure during 15/16. This includes the establishment of a new set of sub-groups plus a Business Management Group to deliver on the board’s strategic vision and work plan.

Statements from key partners The following statements have been provided by some of the key agencies represented on the CESAB. The reports cover adult safeguarding issues from each organisation’s perspective and identify key priorities for 2015/2016

Adult Safeguarding in 2014-15

Cheshire East Council Cheshire East continued to act as the Lead Agency for receiving and investigating all safeguarding referrals in line with the No Secrets Guidance. During 2014/15 a total of 1251 safeguarding referrals were received by the 10 Adult Teams listed on PARIS. Thirty percent were either substantiated or partially substantiated. Most of the referrals were received from hospital staff and the top 3 types of abuse were Neglect, (468) Physical (418) and Psychological.(270). Although the Total number of referrals has remained the same, the types of abuse have changed. In 2013/14 the top type of abuse was Physical rather than Neglect. The Council continued to operate a Threshold Policy and Providers were required to submit Care Concern Data to report low level concerns. During 2014 a total of 1541 care concerns were received. This type of intelligence is used by Commissioners to inform Quality and Contractual standards in Provider settings. In March 2015 a total of 195 staff attended training to introduce Making Safeguarding Personal. Moreover, in March, workshops were held to promote the interface between Domestic Abuse and Safeguarding. Mental Capacity Awareness Sessions were delivered to 202 staff and Mental Capacity Master Classes were attended by 47 staff. Over the past 12 months Cheshire East has moved Adult Safeguarding Activity back into Operational Teams. The rationale for moving the functions away from a Specialist Safeguarding Unit to the Front line teams was to ensure that Safeguarding is Everyone’s business, to encourage Front Line Practitioners to take responsibility for decision making and to maintain consistent practice standards. The changes have also allowed more distinctions between the role of the Adult Safeguarding Board and the Councils activity. In preparation for the Care Act, new policies and procedures have been produced to cover statutory

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requirements. Additional policies have been introduced to address Large Scale Investigations, Persons in Positions of Trust and Sexual Exploitation. An Audit Tool and Practice Standards have been introduced to measure compliance and to demonstrate the culture shift from a Process driven service to a Person Centred/Outcome focussed approach. Liquid Logic will assist Practitioners with their recording, when it is available later in the year. Quarterly Multi Agency Practitioner Forums have been re-launched to focus on discussing case studies, inviting guest speakers and building professional relationships across partner agencies. This year also saw the launch of the Domestic Abuse Hub, which acts as a ONE STOP shop to enable all referrals and concerns to be received at one central point of access. Monthly Safeguarding Governance Meetings are chaired by the Director of Adult Social Care, to ensure that Safeguarding is embedded in each part of the Directorate. Senior Managers participate in both the main Safeguarding Board and the Sub Groups.

How your organisation has captured the Voice of Service Users:

The Service User Reference Group have designed information packs and guidance suitable for both adults at risk as well as staff. Cheshire East have embraced their views about being valued, respected, included and informed and will ensure that the wishes and feelings of adults at risk are heard at the beginning, middle and end of the Safeguarding Process.

The drama Company AFTA THOUGHT introduced the principles of Personalisation to Practitioners and used real case studies to aid their delivery and bring the Principles of Making Safeguarding Personal to life.

Key Issues/ Risks:

Advocacy: The Care Act has increased the demand for advocates to ensure that adults are properly supported in decision making. One of the key risks is that there may not be enough advocates to meet the demand in a timely way.

Reporting mechanisms: Care Providers will be required to report low level incidents in a different way via Key Performance Indicators. It is important that this shift is managed in a safe way.

Key areas of focus for 2015-16 for safeguarding adults at risk:

The key areas of focus for the next year are to

Embed the new Statutory requirements and embed new policies and procedures

Raise awareness about new areas of work, including Human Trafficking, Sexual Exploitation, Self-

Neglect and the Persons In Positions of Trust Policy

Training to ensure staff have the skills in models of interventions for example Restorative Justice,

Conflict Resolution, and Mediation.

New electronic recording systems will be introduced during this financial year and staff will require additional training to ensure accuracy and consistency

Websites will be refreshed to raise awareness about what and how to report abuse.

Adult Safeguarding in 2014-15

Cheshire Constabulary

Within Cheshire Police safeguarding adults is the responsibility of every member of staff. Staff take calls from anyone who has concerns that an adult may be or is at risk. This information is then assessed to decide what should happen next and which department and what action should be taken. This may be;

visits to check on people’s welfare and make sure they are safe

engaging with relatives

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referral to other agencies depending on the nature of the concern If we think a criminal offence has been committed we speak to adult social care and take part in a Strategy Discussion to decide what action should be taken. When we do this we take into account what the adult at risk wants to happen unless that person does not have capacity. We keep contact with the adult at risk and other professionals while we are investigating so that everyone knows what is happening and why. The victim can choose how and when this is done. Where we have completed criminal investigations sometimes the victim has been unable to attend our specialist suite so that their evidence can be recorded on video. Getting the victim’s statement in this way means that they may not have to give that evidence in a court as the video can be used instead. To protect those who can’t attend and make sure they have the same access to justice we have made use of mobile video equipment on several occasions sometimes at hospital and sometimes in nursing/care homes. We have made good use of Section 44 of the Mental Capacity Act 2005 over the last 12 months and carried out a number of investigations in relation to this offence most recently having cautioned two individuals using this offence. This means they can no longer work with vulnerable people. In the last 12 months we have delivered training to all staff about the Care Act 2015, Adults at Risk, and roles and responsibilities of staff. We were fortunate to have support in this training from the Adult Safeguarding Lead for Mid Cheshire Hospital. We have revised our Force Policy to reflect the changes from the new Care Act. We have supported multi-agency training events about Capacity and Deprivation of Liberty particularly to health and social workers. We have given presentations at Practitioners Workshops to improve understanding of the police role in respect of Adults at Risk and our processes for professional referral. We are active members of two Board sub groups, the Training sub group and the Protection sub group.

How your organisation has captured the Voice of Service Users:

Whenever the police have contact with an adult who is thought to be at risk a form is completed with details about the person, what that adult or an advocate has to say, how they feel, what they want to happen, and consider any immediate concerns or risk. This form is then assessed by a specialist department to decide whether any further action should be taken and if necessary passed to other agencies. The police also work to what is called the Victim Code of Practice. This means that where there is a criminal investigation the victim is told about any important steps in the investigation and at a time, place and frequency that the victim wants. These updates are personalised to the wishes and needs of the victim.

Key Issues/ Risks:

There has been a change to the referral process from social care to the police.. The Force is also going through a restructuring process which includes review of areas of responsibility. An additional dedicated Adult at Risk officer has been introduced at the North part of Cheshire East meaning there are now 2 FTE staff. There is a risk resulting from both the process change and the restructure that staff do not fully understand their role/responsibilities affecting initial response. This will not be affected where there is a clear need for immediate or emergency action. The changes are and will be monitored to make sure that the police response is timely and effective, and that the correct process is followed including initial response where a joint agency approach is needed. In addition the 100% increase in dedicated officers will provide the support and expertise colleagues may need.

Key areas of focus for 2015-16 for safeguarding adults at risk:

Embedding of the process change resulting from the revised referral process

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Adult Safeguarding in 2014-15 South and East Cheshire Clinical Commissioning Groups

Adult Safeguarding Policies have been completely reviewed and refreshed to reflect The Care Act and Making Safeguarding Personal in line with the new guidance

Bespoke training for CCG staff on Adult Safeguarding was undertaken to support findings from an internal audit

From a commissioning perspective, the NHS Safeguarding Commissioning standards document is now a nationally recognised document that supports the NHS Standard Contract in commissioning services, the framework embeds the NHS 6C’s, Safeguarding Adult Principles, Section 11 and the supports the requirement from CQC’s new Safeguarding statement

The CCG showcased through their first Seminar to over 120 delegates, the dedicated work relating to MCA/DoLS from a multi-agency partner perspective, keynote speakers from Central government, police and law all provided their dedicated time.

Clear processes have been implemented to the reporting of Adult Safeguarding within the CCG’s

A flow chart has been developed within health and is available to all professionals in primary care, and the CCG.

There is also a dedicated website for Safeguarding on both CCG websites, all information is the same to ensure consistency, initial website information from the communications team suggest that the safeguarding site is in the top ten of views

Funding for 12 months has been sourced to create a MCA/DoLS practitioner post to support the work of Adult Safeguarding, the dedicated post will cover the Cheshire East footprint and drive the key work necessary to deliver on outcomes relating to MCA/DoLS

Quarterly Safeguarding Assurance meetings continue to provide a robust forum for holding out main providers to account on their safeguarding arrangements internally

The Designated Nurse is Chair of the Learning & Development Sub-Group to the SAB, and has been instrumental in scoping and developing the members of the group to ensure the right people are at the table for decision making

How your organisation has captured the Voice of Service Users:

Public engagement events-Healthvoice meetings every six weeks [membership consists of public retired members with health and social care background]

CCG has public members as part of a reader’s panel to review CCG policies and information documents.

The Caring Together team engage directly with public members on a quarterly basis.

There are also CCG formal Complaints, Serious Untoward Incidents review meetings and the whistleblowing policy for the CCG supports all staff in raising any concerns they may have

Key Issues/ Risks:

MIAA internal audit – highlighted succession planning/risk register/contract monitoring & scope of the roles off the designated nurses as areas of risk

MCA/DoLS Practitioner post funding for 1 year – business case to support a permanent post for the CCG for the vast volume of work that is necessary for the post

Key areas of focus for 2015-16 for safeguarding adults at risk:

Development of a robust risk register for Adult Safeguarding within the CCG’s to measure risks at a corporate level, and ensure the Governing body undertake ownership to reduce the risk

MCA/DoLS Practitioner to raise the profile and support other MCA Leads in primary and secondary care to ensure the best outcomes for our most at risk adults

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Work to raise awareness on the growing concerns relating to Trafficking and Modern Slavery – signs to look for – how to report

Revise the CCG E-Learning Academy training

Adult Safeguarding in 2014-15

NHS England NHS England North (Cheshire & Merseyside) Key Developments over past 12 months

Support given to GP practices with regard to CQC Outcome 7: Safeguarding people who use services from abuse.

Additional resource given to LA to ensure increased capacity for S11 training. The funding enabled increased awareness training of the Mental Capacity Act and Deprivation of Liberty Safeguards.

Additional funding enabled social workers to access the Deprivation of Liberty Safeguards Best Interests Assessors Training, supporting the LA to ensure that DOLS applications are completed in a timely reducing the risk of individual being unlawfully deprived of their liberty and breaching their human rights.

Supporting the delivery of Care and Treatment reviews as part of the response to the Winterbourne View Concordat and the renewed focus and national ambition to discharge patients with a learning disability from an inpatient facility to a community setting if clinically safe to do so.

How your organisation has captured the Voice of Service Users:

NHS England routinely seeks the voice of service users via NHS Voices National Patient engagement team At a local level NHS England North (Cheshire & Merseyside) captures feedback from service users in the form of patient stories. This feedback is provided from:

Complaints

North West Self advocate forum/groups and local LD Partnership boards in respect of learning disability services.

Key Issues/ Risks:

NHS England Key issues/Risks

Gaining whole system safeguarding assurance from all health service provision

Acceptability and completion of Safeguarding assurance audit tool for primary care services. I.e. GP, dental and pharmacy practices.

Key areas of focus for 2015-16 for safeguarding adults at risk:

The key priorities for NHS England during 2015/16 are:

Child Sexual Exploitation – commissioning standards for services who provide long term support; working with partner agencies to prevent CSE

MCA/DOLs – continued work regarding skills and knowledge of frontline staff; work with Coroner regarding GP knowledge of MCA/DOLs

Female Genital Mutilation – Implementation of mandatory reporting across GP Practices

Lampard Enquiry – implementing recommendations from Lampard Enquiry relating to Saville

PREVENT – continue to work with partner agencies regarding radicalisation and PREVENT agenda

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Looked After Children – implementation of new statutory guidance and support for transition work

Adult Safeguarding in 2014-15 Cheshire Centre for Independent Living

Adult Safeguarding is embedded in all services delivered across Cheshire Centre for Independent Living (CCIL). All staff complete annual Safeguarding training and have access to a Safeguarding Officer at all times. CCIL has a referral pathway, process and procedure for any concern raised by a staff member about an adult. During the period 2014-2015, CCIL made 2 referrals to Cheshire East Adult Social Care. The Chief Executive Officer is a member of the LSAB and Chairs the Service User Reference Group to meet the Board Strategic Objective:- to listen to people who have been subject to abuse or neglect, and to seek assurance that people are able to be supported in the way that they want, are empowered to make decisions, and can achieve the best outcomes

How your organisation has captured the Voice of Service Users:

Cheshire Centre for Independent Living is a user led organisation, run and controlled by disabled people for disabled people, that by its very nature is driven by the needs and aspirations of people with care and support needs. Cheshire Centre for Independent Living captures the voice of service users in a variety of formats:

Regular consultation events

Quarterly review of service

Peer Support Groups

Attendance by service users at AGM

Steering Groups CCIL uses a number of communication formats to capture the voice of service users:

PECS

Widget

Large Print

Newsletter

Case Recording

Telephone

Text

Email

Braille (upon request)

Alternative language (upon request)

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Key areas of focus for 2015-16 for safeguarding adults at risk:

CCIL’s key areas of focus for 2015-2016 are:

Ensure all staff complete annual safeguarding training

Ensure Adult Safeguarding remains embedded within all service delivery across the organisation

Ensure the voice of disabled adults is heard and listened to with regard to Safeguarding

Cheshire East Strategic Housing & Registered Housing Providers

Adult Safeguarding in 2014-15 Housing

During 2014/15 Cheshire East Strategic Housing Services and Partner Registered Providers have developed a network of safeguarding lead officers in order to:

Disseminate information

Share good practice

Ensure that we are all have the required policies and procedures in place Cheshire East Housing and Registered Provider staff have received safeguarding training and one indicated that they now have a rolling programme in place to promote safeguarding annually with staff. Another Registered Provider is delivering enhanced Adult Safeguarding training to customer facing staff to ensure that staff are fully equipped to identify and report suspected abuse. Registered Providers have raised awareness of safeguarding through their own publications to ensure that tenants know how to report suspected abuse and the new Safeguarding Newsletter is circulated to the network. The Registered Providers who responded indicated that they have reviewed and have Policy and procedures are in place. Both Strategic Housing and Registered Providers have assisted with the provision of alternative accommodation following Safeguarding reviews.

How your organisation has captured the Voice of Service Users:

Whilst reviewing existing policies Registered Providers have consulted customers and the board in the production of these documents. Information has been provided and advice to some of the most vulnerable residents, including those people living within our Sheltered Housing and Extra Care schemes

Key Issues/ Risks:

Registered Providers have highlighted the following risks/issues:

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Ensure we continue to work in partnership with our Safeguarding Board and relevant teams to safeguard children and adults at risk. We work with a broad range of people who live in our properties or who access our services We are alive to the safeguarding risks that this presents and deploy robust management strategies to ensure that these risks are effectively managed Strategic Housing need to ensure that all Registered Providers have Safeguarding policies and procedures in place. The majority operate across a number of authorities and therefore we cannot ensure that their policies/procedures align with Cheshire East.

Key areas of focus for 2015-16 for safeguarding adults at risk:

There is a variety of activity being undertaken within the housing sector which includes the following: Strategic Housing will continue to be actively engaged in the safeguarding adults agenda contributing towards to the work of the Safeguarding Adults Board and the Task and Finish Groups. We will continue to network with the Local Registered Providers, disseminating information and ensuring that policies and procedures are in place and reviewed on a regular basis. Registered Providers will: Work with Cheshire East and LSB to work jointly for the benefit of victims and their families. Ensure that key messages and areas for improvement/change are communicated internally and externally. Ensuring all our staff understand the six principles in full and adequate training is carried out with key officers. Other areas of work include setting up Corporate Safeguarding groups, rolling out Professional Boundaries training to staff in Independent Living Teams. Strengthening Safeguarding internal reporting arrangements. Both Strategic housing and Registered Providers will continue to raise awareness of Safeguarding issues with both tenants and residents.

Adult Safeguarding in 2014-15 Cheshire Fire & Rescue

Cheshire Fire & Rescue Service delivers prevention, protection and emergency response services to the communities of Warrington, Halton, Cheshire East and Cheshire West & Chester in fulfilment of statutory requirements stated in the Fire & Rescue Services Act. In doing so the Service contributes to safeguarding vulnerable adults through its attendance at emergency incidents, prevention activity such as Home (Fire) Safety Assessments and in its enforcement activity in residential care premises. The Service plays an active role in partnership working in the area of adult safeguarding so as to maintain organisational awareness and deal effectively with those situations where adults at risk may be in need of

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assistance and support. The Service continues to be a member of the Board structures in all four local authority areas it serves. Progress report for 2014 – 2015

The Service has had a safeguarding adults at risk policy and procedure document since 2011, it was reviewed in 2012/13 with front-line staff receiving refresher training throughout 2014/15. A 2015 policy review is programmed.

In 2014 the Service commissioned an external training provider to deliver adult safeguarding Train The Trainer skills to key Prevention managers who then rolled out a bespoke staff training programme. This programme of training has further up-skilled the Service’s in-house training capacity as well as front-line awareness on recognising and reporting adult abuse and neglect.

The Service continues to utilise LSABs to promulgate fire risk awareness amongst those agencies and professionals offering services to those who may be at heightened risk from fire.

As a member of the Board the Service will look to continuously develop the fire risk awareness of professionals and the wider community so that risk from fire is fully integrated with the well being of any adult at risk.

How your organisation has captured the Voice of Service Users:

As the Service is not a provider of health or care services per se we focus on receiving service user experiences through our annual consultation process and specific customer satisfaction surveys for our emergency response, prevention & protection activities. In addition we have formal procedures for receiving and handling compliments and complaints.

Key Issues/ Risks:

A key issue for the Service relates to maintaining fire risk awareness amongst professionals and/or volunteers providing care and assistance to those meeting adult at risk criteria. We therefore remain committed to continually strengthening our collaboration with other agencies so that fire risk is not only a key consideration for all those that are in receipt of care services or assisted living arrangements but particularly for those that require a more concerted multi-agency approach.

Key areas of focus for 2015-16 for safeguarding adults at risk:

In 2015-16 Cheshire Fire & Rescue Service will be looking to use its position within LSABs and on the Pan-Cheshire Mental Health Strategic Board to raise awareness of the links between mental health, alcohol, smoking and increased likelihood of falling victim to fire. It is anticipated that this could lead to further collaboration between agencies so as to reduce the likelihood of those meeting adult at risk criteria dying in a fire in a domestic dwelling, residential care home or other environment that provides for the health, safety and well-being of the adult at risk. The Service is commencing development of an internal Dementia Friends training programme. The training itself is programmed to be delivered later in 2015/16 and will assist our staff in engaging with and supporting those with dementia who may also meet adult at risk criteria.

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Adult Safeguarding in 2014-15 North West Ambulance Service

The Trust has a legal duty to protect patients, staff and the public from harm. This includes harm from others as well as avoidable harm to patients. The Clinical Safety and Safeguarding Team have worked hard during the year to identify patients at risk and have focussed the following work streams to ensure patients and the public receive appropriate care and protection when required. The implementation of the new Care Act 2014 provides a legal framework for the assessment and protection of adults including those at risk with an emphasis on the ‘wellbeing’ of the patient. This may account in part for the notable rise in safeguarding adult activity over the year which includes concern for the welfare of vulnerable adults requiring assessment. Likewise safeguarding children activity steadily increases across the trust particularly within the Paramedic Emergency Service but at a slower rate than for adults. A number of high profile national investigations have resulted in an update to safeguarding procedures and training to ensure that adults and children who are at risk or victims of exploitation and radicalisation are also safeguarded. Achievements

CQC pilot standards The Trust took part in the CQC pilot assessments of Ambulance Service NHS Trusts. The result is that a number of standards have been developed for Ambulance Services and good assurance was received in relation to safeguarding arrangements.

Engagement with Safeguarding Boards The Trust has a named contact for each of the 46 Safeguarding Boards across the North West. This strengthens working together and information sharing relationships and is reflected in the increased number of Serious Case Reviews, Safeguarding Adult Reviews and Domestic Homicide Reviews. Staff also access multi-agency training and share learning and expertise with their peers.

Frequent caller Project and vulnerable people. The safeguarding and frequent caller teams are regularly identifying and sharing information to enable a joined up approach to ensure vulnerable people are afforded the assessment and care they require in accordance with their wishes. When appropriate they are protected from harm or abuse and a significant amount of valuable patient data is now shared to ensure the best outcomes for these patients. This also includes sharing concerns in relation to nursing and Care Homes.

Update of the safeguarding Vulnerable Persons Policy and Procedures A significant amount of work has been done to update the Policy and associated procedures. These now include the principles of adult safeguarding and pathways are included for victims of Child Sexual Exploitation (CSE), Female Genital Mutilation (FGM) and the radicalisation of vulnerable people (PREVENT).

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PREVENT awareness and training Over 75% of all NWAS staff have received WRAP 3 training which is the ‘Workshop to Raise Awareness of PREVENT- part of the government’s anti-terrorism strategy. WRAP is included within mandatory training for all staff and compliance with this national requirement continues to increase monthly.

Adult Safeguarding Figure 1 Adult Safeguarding Referrals by area

Figure 1 shows the number of safeguarding adult referrals across Q1 to Q4 2014-2015. Referral rates across all sectors continue to increase year on year by as much as approximately 50% in each area. The referrals include adults at risk and adults requiring an assessment. All referral information is shared using the Trust’s web-based system (ERISS) to ensure security and ease of access to referral data. Proposed development 2015- 2016

Safeguarding alerts The Electronic Information Sharing System (ERISS) is a bespoke web-based system used by the Trust for sharing safeguarding referral information with Children’s and Adult Social Care. This system has the functionality to place warning flags to alert the attending crew about child or adult protection issues. The application will be piloted over the forthcoming year. The current position of staff raising alerts with the Trust Safeguarding Team remains in place.

Domestic Abuse The Trust is continuing to develop processes in relation to Domestic Abuse. Following the success of the pilot last year a referral form for domestic abuse will be developed with provision for enhanced information sharing which links to the national guidance (NICE).

Sexual exploitation, Slavery and Trafficking The Trust Safeguarding Team is in the process of developing links with all the CSE Teams in the North West to enable efficient and timely information sharing in relation to CSE. This is over and above the current safeguarding procedures already in place. There is also a process to capture data relating to FGM which has been communicated to all staff and this will be monitored during the year. The Trust is working with partners to help tackle issues relating to Slavery and Trafficking of children and adults. This work is in the initial scoping phase and any identified actions will be added to the Safeguarding Work Plan for the year and progress monitored.

746 507

1131

2384

739 587

1130

2456

800 605

1078

2483

830 616

1083

2529

0

1000

2000

3000

Cumbria & Lancs Cheshire & Mersey Greater Manchester Total

Safeguarding adult referrals 2014-2015

Qtr 1

Qtr 2

Qtr 3

Qtr 4

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Annual Assurance Statements for Cheshire East SAB 14/15 All partners completed an assurance document as part of ensuring that the SAB can be satisfied that agencies are working together to safeguard the citizens of Cheshire East and improved outcomes during 2014/15. The information gathered from these statements will be used to support any national or regional benchmarking of safeguarding activity and to identify where additional work needs to be undertaken during 2015/16. Intelligence about partner organisations will help to ensure that CESAB is better prepared and able to plan ahead to meet future changes and challenges. Partner’s statements were written against the Care Act’s 6 Key Principles of Empowerment, Protection, Prevention, Proportionality, Partnership and Accountability in relation to Safeguarding Adults

Using best practice examples, each of the organisations listed above were able to give at least two examples of systems/practices in place which show clearly how their organisation is assured that they are meeting each standard. Examples of statements given: “Patient’s feedback on their experiences is used to develop the way we work” “The training programmes have led to services being offered in a way which prevents abuse occurring in the first place” “We are more able to quickly identify where abuse has occurred” “Safeguarding activity is person centred, not process led” “Our database records all safeguarding activity and can identify rationales, emerging themes etc.”

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Domestic abuse continues to be a significant safeguarding issue for adults at risk in Cheshire East with multiple and often long lasting impacts on safety, health, wellbeing and achievement. As domestic abuse is often linked to substance misuse and mental ill health cases can involve a degree of complexity and interrelated harm which makes safeguarding and co-ordination both challenging and vital across a range of agencies and Boards. Cheshire East Domestic Abuse Partnership (CEDAP) highlights the work it has undertaken over 2014/15 in the embedded report

CEDAP LSAdultsB Report 2014-15.docx

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How have we made a difference? In 2014/15 the Cheshire East Safeguarding Adults Board has undertaken detailed preparatory work for the implementation of the Care Act 2014. This included reviewing the role, responsibilities, membership and infrastructure of the Board. The vision and principles of the board were established; along with the formation of the structure of the board and its governance arrangements. The Board also defined its powers and duties; i.e. the set of rules by which the Board will operate. The key functions of CESAB in 2014/15 can be grouped into seven broad areas:

- Strategic planning

- Producing multi-agency policies, procedures, protocols and guidance

- Quality Assurance regarding the responsibilities of agencies including commissioners,

partners, the Board itself and through learning from Safeguarding Adults Reviews

- Ensuring participation and involvement by people who use services and carers as key

stakeholders (both in their own safeguarding and in the work of the Board)

- Active promotion of safeguarding including awareness raising and publicity

- Oversight of learning and workforce development

- Partnership working and managing key stakeholder relationships

To perform these functions 2014/15 saw the -

- Establishment of an effective mechanism to involve people who use services

in the work of the Board

- Public consultation exercises to aid the development of the Strategic Plan

- Introduction of a CESAB Social media presence via the establishment of Facebook and Twitter pages

- Reorganisation of the Board’s administrative arrangements i.e. Review of: the frequency of meetings, work plan, format of agendas and papers.

- Public awareness campaigns – linking with White ribbon Day, Action against Elder Abuse and Dignity in Care Day

- Focussed work on Financial Abuse – including the development of a financial Abuse Toolkit for frontline staff

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- Development of a risk matrix for the work of the Board

- Implementation of the Board internal standards and how Board effectiveness is assessed – e.g. annual Board appraisal and the development of an Assurance Framework

- Review of Cross-cutting issues: CESAB, LSCB, the Community Safety Partnership and the Health & Wellbeing Boards designed a Cross Cutting Issues management arrangement. Each cross cutting issue has been allocated to one of the Boards as the lead board, with the expectation that links are made with other boards to take forward joint work. The cross cutting group agreed that Chairs and Lead officers should meet twice a year to ensure that issues are being captured, investigated and assurances provided. The respective boards will lead on the following issues:

Shared priority area Strategic governance lead

Domestic Abuse Community Safety Partnership

Terrorism and Prevent Community Safety Partnership

Reducing Offending Community Safety Partnership

Anti-social Behaviour Community Safety Partnership

Organised crime Community Safety Partnership

Hate Crime Community Safety Partnership

Sexual exploitation Local Safeguarding Children Board

Trafficking and Modern Slavery Cheshire East Safeguarding Adults Board

‘Mate crime’ Cheshire East Safeguarding Adults Board

Substance misuse Health &Well Being Board

Mental Health Health &Well Being Board

Once each Board has written their local strategy for their lead issue, a review will take place in 2015/16 to ensure these strategies are all aligned.

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What next? 2015/16 & beyond – 2014/15 was an incredibly positive year for CESAB. With the revised Constitution and three year strategy now in place, the board are looking forward to the work of 2015/16 with the implementation of the Care Act and the Board’s statutory status. The Board’s three year objectives for 2015/16–2017/18 are set out in CESAB’s Strategy Document, aligned with the various work streams of the Board, each year, when the Business Plan is agreed for the next 12 months, it will include various elements of these three year objectives. This will help to focus on longer term goals that need to be worked towards over a lengthier period of time. Some of CESAB’s priorities and key actions for the upcoming year are listed below and they are embedded in the CESAB Business Plan for 2015/16:

Ensure that a ‘making safeguarding personal’ approach to adult safeguarding is embedded in practice in Cheshire East. The “Making Safeguarding Personal” initiative is a national initiative that couples the Care Act 2014. It sets out to develop person-centred responses to safeguarding circumstances. It encourages local authorities and their partners to develop a range of responses they can offer to people who have experienced harm and abuse, so that they are empowered and their outcomes are improved.

Ensure that people involved in safeguarding have the appropriate skills and knowledge to deliver a personalised approach

Introduce a regular adult safeguarding newsletter to promote CESAB’s work and inform the public and the wider health and social care sector about adult safeguarding issues

Launch an independent CESAB Website that has been designed and developed by local service users

Ensure people have access to information and advice about protecting themselves, and what to do if they are being harmed or abused.

A key role of the Board is to seek ways to continually improve standards of practice and outcomes for people within the safeguarding adults procedures. One way in which the CESAB achieves this is through its performance, audit and quality assurance processes. A new partner audit has been developed and will be issued in 2015/16. A public consultation is also planned along with other means to improve the ways of capturing service users experiences and perceptions of the adult safeguarding process in Cheshire East.

Make sure all staff is aware about the Mental Capacity Act and the use of Independent Mental Capacity Advocates role in safeguarding work.

Ensure all partners have plans to check that people who use services are treated with dignity and respect.

Continue to embed safeguarding in commissioning, contracting and grant arrangements

The Board Business Plan 2015/16 and Strategy Document is available on the Cheshire East Safeguarding Adults Board website

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Easy Read Appendix 1

What is the Cheshire East Safeguarding Adults Board and what do they do to keep me safe?

Information designed by the Service user Sub-Group

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email – lsab@cheshireeast.gov.uk